<div class="container">
<div class="row">

	<div class="span12">
		<ul class="breadcrumb">
			<li><a href="#">Home</a> <span class="divider">/</span></li>
			<li><a href="#">Account</a> <span class="divider">/</span></li>
			<li class="active"><a href="#">Register</a></li>
		</ul>
		</div>

			<div class="span12">
				<h1>Create an account</h1>
				
				<br>				
				<form class="form-horizontal">
					<fieldset>
					<div class="span6 no_margin_left">
						<legend>Your Personal Details</legend>
					  <div class="control-group">
						<label class="control-label">First Name</label>
						<div class="controls docs-input-sizes">
						  <input type="text" class="span4" placeholder="">
						</div>
					  </div>
					  <div class="control-group">
						<label class="control-label">Last Name</label>
						<div class="controls docs-input-sizes">
						  <input type="text" class="span4" placeholder="">
						</div>
					  </div>					  
					  <div class="control-group">
						<label class="control-label">Email Address</label>
						<div class="controls docs-input-sizes">
						  <input type="text" class="span4" placeholder="">
						</div>
					  </div>					 

					  <div class="control-group">
						<label class="control-label">Telephone</label>
						<div class="controls docs-input-sizes">
						  <input type="text" class="span4" placeholder="">
						</div>
					  </div>
					  </div>
					  <div class="span6">
					<legend>Your Address </legend>
					  <div class="control-group">
						<label class="control-label">Address 1</label>
						<div class="controls docs-input-sizes">
						  <input type="text" class="span4" placeholder="">
						</div>
					  </div>
					  <div class="control-group">
						<label class="control-label">Address 2</label>
						<div class="controls docs-input-sizes">
						  <input type="text" class="span4" placeholder="">
						</div>
					  </div>					  <div class="control-group">
						<label class="control-label">City</label>
						<div class="controls docs-input-sizes">
						  <input type="text" class="span4" placeholder="">
						</div>
					  </div>
					  <div class="control-group">
						<label class="control-label">ZIP</label>
						<div class="controls docs-input-sizes">
						  <input type="text" class="span4" placeholder="">
						</div>
					  </div>					  <div class="control-group">
						<label class="control-label">Country</label>
						<div class="controls docs-input-sizes">
						  <input type="text" class="span4" placeholder="">
						</div>
					  </div>
					  </div>
					  
					<div class="span12 no_margin_left">
					<legend>Your login </legend>
					<div class="span6 no_margin_left">
					  <div class="control-group">
						<label class="control-label">Username</label>
						<div class="controls docs-input-sizes">
						  <input type="text" class="span4" placeholder="">
						</div>
					  </div>					 
					  </div>					 
<div class="span6">
					  <div class="control-group">
						<label class="control-label">Password</label>
						<div class="controls docs-input-sizes">
						  <input type="text" class="span4" placeholder="">
						</div>
					  </div>					  <div class="control-group">
						<label class="control-label">Confirm password</label>
						<div class="controls docs-input-sizes">
						  <input type="text" class="span4" placeholder="">
						</div>
					  </div>
					</div>

					  
					  

					  
					  </div>

					
				<div class=" span12 no_margin_left">
					<hr>
					<div class="span8">
						<input type="checkbox" name="optionsCheckboxList1" value="option1"> I have read and agree to the Privacy Policy<br>
						<input type="checkbox" name="optionsCheckboxList2" value="option2"> Subscribe to our newsletter
						
					 </div>
					 <div class="span3"><button type="submit" class="btn btn-primary btn-large pull-right">Register</button></div>
					 <hr>
          </div></fieldset>
				  </form>
	  
			</div>
		
		<hr>


	
</div>
</div>